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Open Access Research article

Smoking cessation and the risk of cardiovascular disease outcomes predicted from established risk scores: Results of the Cardiovascular Risk Assessment among Smokers in Primary Care in Europe (CV-ASPIRE) Study

Pablo Mallaina1*, Christos Lionis2, Hugo Rol3, Renzo Imperiali4, Andrew Burgess5, Mark Nixon5 and Franco Mondello Malvestiti1

Author Affiliations

1 Primary Care BU Europe, Pfizer, Walton Oaks, Pfizer, Walton Oaks, Dorking Road, Surrey KT20 7NS, UK

2 Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Crete, Greece

3 Bennebroek Primary Care Center, Bennebroek, The Netherlands

4 Primary Care Varese ASL, distretto di Tradate, Italy

5 Real-World and Late Phase Research, Quintiles, Reading, UK

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BMC Public Health 2013, 13:362  doi:10.1186/1471-2458-13-362

Published: 18 April 2013



Smoking is a major risk factor for cardiovascular disease (CVD). This multicenter, cross-sectional survey was designed to estimate the cardiovascular (CV) risk attributable to smoking using risk assessment tools, to better understand patient behaviors and characteristics related to smoking, and characterize physician practice patterns.


1,439 smokers were recruited from Europe during 2011. Smokers were ≥40 years old, smoked > 10 cigarettes/day and had recent measurements on blood pressure and lipids. CV risk was calculated using the SCORE system, Framingham risk equations, and Progetto CUORE model. The CV risk attributable to smoking was evaluated using a simulated control (hypothetical non-smoker) with identical characteristics as the enrolled smoker. Risks assessed included CV mortality, coronary heart disease (CHD), CVD and hard CHD. Demographics, comorbidities, primary reasons for consultation, behavior towards previous attempts to quit, and interest in smoking cessation was assessed. Dependence on nicotine was evaluated using the Fagerström Test for Nicotine Dependence. GP practice patterns were assessed through a questionnaire.


The prediction models consistently demonstrated a high CV risk attributable to smoking. For instance, the SCORE model demonstrated that this study population of smokers have a 100% increased probability of death due to cardiovascular disease in the next 10-years compared to non-smokers. A considerable amount of patients would like to hear from their GP about the different alternatives available to support their quitting attempt.


The findings of this study reinforce the importance of smoking as a significant predictor of long-term cardiovascular events. One of the best gains in health could be obtained by tackling the most important modifiable risk factors; these results suggest smoking is among the most important.

Cardiovascular; Diseases; Europe; Model; Smoking; Cessation; Framingham; SCORE; Progetto; ASPIRE